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Motivating youth: Community representatives have been crucial in the fight against HIV/AIDS.

Dr. James Blanchard, Project Director, India-Canada HIV-AIDS Prevention Project (ICHAP), who played a critical role in designing and planning the Project, says, “Way back in 1999-2000, we had some idea about the epidemic in North Karnataka but we did not know the magnitude of the problem, especially in districts like Bagalkot. Once we learnt about it, we faced the onerous challenge of mounting a scaled-up response.”

Dr. Blanchard attributes the success of the programme to the cohesive response ICHAP facilitated. “Our technical expertise in the area of public health as planners and researchers, together with the involvement of different segments of society such as farmers, youth and women and societal leaders, helped create a model for a community-led rural response to HIV. Community representatives such as the ‘Link Worker’ have played a critical role in the success of the programme.”

The Link Workers forged the ‘link’ between the community and the programme. They went from house-to-house, and village-to-village, dispelling myths about HIV; motivating people to access services such as treatment for sexually transmitted infections, testing for HIV, and treatment for opportunistic infections among positive people.

Criteria for Link Workers included belonging to the village, ability to read and write, and good communication skills. In many cases these dynamic men and women themselves came from marginalised communities. Many had faced some trauma — as people affected by HIV or as young widows — and had overcome it. This made them extremely motivated as well as determined social workers. These ‘change makers’ played a key role in altering the face of the village.

In 2007, four years after an intensive response, the project continues to make a visible impact in remote villages of Bagalkot District. There are elderly women who have lost sons, daughters and their spouses to AIDS, and are looking after grandchildren. However, community leaders point out a basic difference: Unlike in the 1990s, today people have not only taken charge of HIV but are determined not to let any disease, be it malaria or chikungunya, come in the way of their well-being.

They are taking no chances; there is increased health awareness and Village Health Committees are looking into not just sanitation and health education, but also issues like school enrolment, widow remarriage and discouraging child marriage. Information and awareness about HIV and services have helped counter the stigma and discrimination against HIV Positive people to a large extent.

The yeoman work by link workers such as Manohar Macha, 44, can be understood when we rewind to the 1990s and compare the mood and morale then and now.

Then, they perceived themselves as being struck by an unimaginable disaster called HIV — seen as “irrevocable destiny or Karma”. On the face of it, like all rural communities, they tell you how they bore it stoically and silently.

However, when one probes deeper, they will admit that HIV brought out the worst in them. Seized by deep fear and feverish anxiety they acted in a knee-jerk manner.

“They were so frightened and desperate to protect the rest of the near and dear ones that they took drastic and inhuman steps. They isolated HIV positive people and built make-shift huts for them in the fields, denying them basic care, nutrition and medical help,” said Nagaraj, a District Coordinator then associated with ICHAP. He narrates how in one village people burnt the hut of the deceased HIV positive person — the body, belongings and the hut all together.

Bhim Sen Guler, President, Village Health Committee, Kadlimatee village, 35 kilometres from Bagalkot town, says Macha, who has been the village’s constant friend, guide and mentor, helped them form the VHC. Currently part of “Samastha”, the Integrated HIV Prevention and Care Project being implemented by Karnataka Health Promotion Trust and supported by USAID,

Macha has a track record of community health over 20 years. “My stint as a healthcare worker began in 1982 when I was appointed as a voluntary and honorary Community Health Guide. I spent a significant part of the early years in reaching out to leprosy-affected people, motivating men to adopt vasectomy as a family planning method, enabling women to access safe sterilisation and maternal healthcare. This taught me that, as a community worker, if there is any single need that we need to address, it is to let people know how to access services, including information. This one-point thrust and formula has guided me all along.” In 2003, link workers like Macha entered villages and began to lead from the front.

Working in five villages, including his own village, Achanur, and neighbouring Kadlimatee, he recalls the early days with great patience and forbearance. “The community was so frightened and in such a beleaguered state of mind that even I was tarnished with the same brush, chided and taunted as an “HIV-wallah” a bearer of polluted and sinful ideas.”

At this stage, he decided not to be cowed down and trod a lonely but determined path. Once in 2003 when the whole community shunned a HIV positive woman and and her child, he demonstrated to the family and community that they had nothing to fear.

“I was not able to save the mother; she died a few weeks later. But I reunited the child with the family,” he states, with visible relief.

Today he is affectionately known as “AIDS Uncle”. He realised early that the young men who were shunning him would sooner or later know the worth of his information, advice and support.

Sure enough, in six months the transformation occurred and Macha made his first conquest by winning over a youth leader. Together with Ramesh, he succeeded in winning over the youth, providing them information and services they needed.

This went a long way in ensuring that many stopped short of getting infected with HIV or other sexually transmitted infections.

Ramesh says: “Once we understood that Macha was striving to help us to take care of our health, reduce young people’s risk of contracting HIV, we used him as a resource in more ways than one. He not only educated us and helped us access health services, but also became a confidant of the youth. He clarified many doubts and concerns we had and soon became someone who bridged the gap between the village youth and the elders.”

Guler agrees: “Over the last three years, ever since we decided to prevent the spread of HIV-AIDS in our communities and realised that much of our health problems are man-made, we are making all possible efforts to build a healthy and definitely a more socially conscious village.”

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